Star Health and Allied Insurance Company Limited

Tariff Statement - Mini SOC ( FINALISED )

Hospital Name :
Hospital Address:
Proprietor Name:
TPA Coordinator Name / SPOC : Phone No:

Room Charges *: Including Nursing, RMO, Duty Doctor, Diet, Injection, Infusion, Mini Soc
A.) Lab Charges
Catherisation & Cannulation Charges Quotation

S.No Category No of Beds 29 BT/CT

Mini Soc All Specialist Visit
Quotation Charges / day 30 Prothrombin Time (PT) / INR

1 General Ward 31 Partial Thromboplastin Time (aPTT)

2 Semi private/ Sharing non AC 32 Lipid Profile
3 Single room non AC 33 Thyroid Function Tests
4 Semi private/ Sharing AC 34 Smear for MP and MF - QBC

5 Single room A/C 35 Blood - Culture & Sens vity

6 Deluxe Room 36 Typhidot (IgM)
37 Blood Widal
ICU Charges: Including Monitor, Pulse Oximeter/Pumps Including
B) /Syringe Pump & Infusion Pump/Catherisation/Cannulation Charges, 38 Dengue NS1 Antigen (CARD)
etc.,(All Inclusive Charges / Day)
39 Dengue Serology IgM(CARD)
7 ICU/ICCU/MICU 40 Dengue Serology IgG (CARD)
8 Neonatal ICU / PICU 41 Leptospira IgM (CARD)
9 Phototherapy charges / Day 42 Leptospira IgG (CARD)
10 Physiotherapy Charges /Day 43 Throat swab H1N1

Ventilator Charges including Invasive 44 PCR H1N1

11
Oxygen /Day Non Invasive 45 PCR Chikungunya

12 Oxygen Charges / day 46 An streptolysin O (ASO)

C) Operation Theater Charges : All Inclusive 47 CCP
Operation Theater Charges
13 48 RA Factor
1st Hrs (Major) :
Operation Theater
14 49 Blood Grouping And Rh Typing
Additional Hours :
Mini Soc
D) Lab Charges 50 Arterial Blood Gas Analysis (ABGA)
Quotation
15 Haemoglobin 51 Sputum for AFB

16 Platelet Count 52 Complete Urine Examina on

17 Complete Blood Count 53 Culture & Sens vity - Urine

18 CRP 54 D-Dimer

19 Blood Sugar - Fasting / PP / Random 55 Ferritin

20 Hba1C 56 Lactate dehydrogenase (LDH)
21 Blood Urea 57 Procalcitonin
22 Serum Creatinine 58 Interleukin- 6 (IL6)
23 Serum Electrolytes E) Imaging Investigations:
24 Blood Uric Acid 58 CT chest

25 LFT 59 Chest X-Ray

26 Hep C (CARD) 60 ECG

27 HBsAg (CARD) 61 ECHO

62 TMT
63 USG Whole Abdomen & Pelvis
Note: a.) Kindly quote charges for all the facilities given above.
b.) Kindly mention “Not Applicable “ for services / Infrastructure which are not available.
c.) This Tariff Statement - Mini SOC is valid for a period of 3 years from the date of acceptance by both the parties.
d.) Discount agreed by the hospital with STAR is applicable on the above mentioned tariff
For Hospital: For Star Health and Allied Insurance Co. Ltd
Name of the Designated Official:
Date:

Signature & Seal of Designated Official / Hospital